Lost in translation State’s Hispanic population faces health care challenges

By April Wilkerson  April is a reporter in Oklahoma City. Contact her at 278-2849. 

Posted: 09:13 PM Tuesday, May 17, 2011

OKLAHOMA CITY – Over the past decade, Oklahoma’s Hispanic population has nearly doubled – to about 332,000 people, according to the latest census data released earlier this year.

That makes Hispanics the state’s largest minority population. But when it comes to health care, Hispanic people often face access issues, cultural and language barriers and long waiting lists that can result in medical conditions getting worse before they get better.

A growing anti-illegal immigration sentiment in Oklahoma also has taken a toll. When Hispanics are worried about their family’s livelihood, they tend to put medical care on the back burner, some providers say.

But Oklahoma’s medical providers and organizations that particularly devote their resources to serving the Hispanic population are fiercely devoted to seeing they get the health care they deserve.

“A lack of cultural competency among medical providers, as well as language barriers, create huge health care disparities,” said Claudia Barajas, director of health services at the Latino Community Development Agency in Oklahoma City. “I have seen progress since I have been here – more and more organizations are hiring bilingual people and trying to accommodate Hispanics’ needs. But it’s not proportional to the way the population has been growing.”

The LCDA offers 22 programs, ranging from immunizations to mental health to substance abuse treatment, and serves about 80,000 people every year, both undocumented and U.S. citizens, Barajas said. The organization could see many more people, if not limited by funding and staff, she said.

Hispanics face many of the same health care issues as other Oklahomans – obesity, diabetes, cardiovascular disease, Barajas said. But for many Hispanics, those changes started occurring after their arrival in the United States. In their home countries, fruits and vegetables were more accessible and less expensive, and they got their exercise by walking.

“In the United States, we’ve changed our style of living; we started driving more, eating more carbohydrates,” she said. “It’s still a person’s choice to do those things, but we started being at higher risk of diseases because of the lack of physical activity and lack of fruits and vegetables. The levels of stress increase, as well as the levels of family dysfunction, because they start working two or three jobs trying to pursue the American dream and have everything that other people have. The families become neglected, and we see more teen pregnancy problems and gangs. It’s not the fault of the United States, but it’s the process of how Hispanics have become more high risk for diseases they didn’t used to face as much.”

To help people get the most from their doctors’ visits, the Hispanic Initiative at Integris Health is beginning a health literacy series this month, said Maria Aymat, director of the program. Hispanic culture has dictated that the patient doesn’t need to ask questions of the doctor, but that needs to change if someone doesn’t understand what to do with instructions or a prescription, even if it is in Spanish, she said.

“If you’re not health-literate, there are a lot of things you cannot process in order to make right decisions,” Aymat said. “It’s not because you don’t want to be compliant; it’s because you don’t know. We’ll work on a lot of these issues. If there’s one thing we promote, it’s that when you go to the doctor and they ask what kind of medicine you use, you can no longer say, ‘I don’t know; it’s a little white pill.’ There are a lot of white pills out there. We need to have a journal, something to have all the information handy.”

Much of the three-person staff’s work at the Hispanic Initiative involves helping people navigate the health care system and connecting them with resources, Aymat said. Navigating medical care is hard enough for someone whose native language is English, she said.

“I can understand how difficult it is, especially when you don’t know what to expect,” said Aymat, who came to Oklahoma from Puerto Rico 28 years ago. “If they happen to have any kind of health insurance, they don’t know how to use it. And let me tell you, a Hispanic in distress is hard to understand. So you can imagine going to health care, especially an emergency room, where nobody speaks the language and you’re already having pain. All of these problems add to the distress that you already have.”

Since 2007, most members of SoonerCare (the state’s Medicaid program) and new applicants must provide proof of their citizenship and identity in order to receive services. An exception is the Soon-to-be-Sooners program, which covers prenatal care for pregnant women whose babies will be U.S. citizens once they’re born.

That’s why safety-net providers are so important to the Hispanic population. Variety Care, a federally qualified community health center with facilities around the state, sees low-income and uninsured patients across the racial and ethnic spectrum, but about 60 percent of patients identify as Hispanic, said Lou Carmichael, executive director.

The Hispanic community is savvy about knowing where they’ll be welcomed for treatment, she said. Community health centers see anyone regardless of ability to pay, she said, and staff members don’t ask whether a patient is a citizen. As a nonprofit organization, they don’t have to ask. But because Hispanics in Oklahoma tend to have lower-paying jobs and less insurance, they face the same health care access issues as other lower socioeconomic groups, she said.

“Our issue in Oklahoma is that people who live in poverty don’t have health care insurance,” Carmichael said. “If they don’t have insurance, they don’t have access. I think we will see more of a problem as gas gets to $4 or $5 a gallon. Just getting to work will become an obstacle. That’s tough. Preventive health care will not be at the top of the list.”

Variety Care offers the range of medical services, and translators are onsite to interpret several languages. There is a growing need for mental health services, but there aren’t enough bilingual licensed therapists to see patients, said David Howlett, director of behavioral health.

“Access is also driven by a language barrier – you can’t use a translator effectively in mental health like you can in medical health,” he said. “Our challenge is finding bilingual licensed therapists. There aren’t enough in Oklahoma City. Hispanics’ mental health needs are the same, but there’s a waiting list.”

Unfortunately, that coincides with Hispanics’ growing awareness and acceptance of mental health treatment, said Barajas, who also has a lengthy waiting list for such services at the LCDA.

“It used to be taboo in the Hispanic community,” Barajas said, “but because we’ve been in the community for so many years, we’ve educated them about the need for treatment, therapy or to learn a little more about their mental health.”

Dental care also can be difficult for Hispanics to access. A mobile dental unit comes to the LCDA monthly, but a lack of money means the patient load is capped, Barajas said. At Variety Care, dentists see many patients who have either never received care or have periodontal disease, said Dr. Meghan Hodges. Dentists also see the worst of problems, including dental implants fashioned of aluminum cans and put into patients’ mouths at illegal, out-of-the-way settings, she said. But they also are making inroads with children, getting them into regular exams early, she said.

An overarching problem is that, in the last year, Oklahoma’s political furor over immigration has put a damper on Hispanics’ seeking out health care, Barajas said. When parents are worried about whether their children will still be at the day care when they get home from work, their top priority isn’t medical checkups, she said. Others have turned to alcohol and substance abuse to deal with the stress, she said.

“It’s pretty strong – this climate and the way they feel,” she said. “We’ve done focus groups, and their biggest fear is being separated from their families.

“When House Bill 1804 (Oklahoma’s anti-illegal immigration bill) was implemented in 2007, we saw a lot of fear,” Barajas said. “For about six months to a year, people were very concerned. After a year, people started calming down when they saw it wasn’t fully implemented. But there were isolated cases where people were deported or went to the emergency room and were given a Tylenol and told to go home. Now the fear is coming back, and it’s higher than in 2007 because people know about the isolated incidents and they know what’s going on.”

Barajas and her staff have advocated for Oklahoma Hispanics in Washington, D.C., pushing for immigration reform at the federal level rather than through state legislation.

Meanwhile, Barajas and her fellow providers push on, trying to connect as many Hispanics as they can with services.

Jorgee Reyes, a women’s health care nurse practitioner at Variety Care’s Straka Terrace clinic in south Oklahoma City, said the fact that her patients trust her and confide in her means everything.

“I love my work,” Reyes said. “The joy is there. They’re my people.”